Background: Diffusing capacity (Dlco), an independent predictor of morbidity after major lung resection, is not used routinely in preoperative evaluation because of a perceived lack of value in patients with normal spirometry. We evaluated the potential utility of measuring Dlco for assessment of operative risk in lung resection patients with normal spirometry. Methods: A retrospective review was conducted for patients undergoing lung resection from 1980 through 2006 to identify predictors of postoperative morbidity. Patients were divided into groups with or without chronic obstructive lung disease (COPD), defined as a ratio of forced expiratory volume in the first second to forced vital capacity of less than 0.7 or a ratio of 0.7 or greater, respectively. Analyses for each group identified covariates for three outcomes: operative mortality, pulmonary morbidity, and overall morbidity. Results: Of 1,046 patients in the database, 1,008 (545 men; mean age, 61.8 +/- 0.35 years) had data permitting determination of COPD status: 450 (45%) with COPD, 558 (55%) without COPD. Operations included lobectomy (752; 75%), bilobectomy (83; 8%), and pneumonectomy (173; 17%). Overall mortality, pulmonary morbidity, and overall morbidity incidences were 59 (5.8%), 140 (14.0%), and 311 (31.4%), respectively. Pulmonary morbidity and operative mortality were related to postoperative predicted Dlco, age, and performance status in patients with and without COPD. The postoperative predicted Dlco was the single strongest predictor of pulmonary morbidity and operative mortality in both patient groups. Overall complications were related to postoperative predicted Dlco only in the COPD group. Conclusions: Diffusing capacity is an important predictor of postoperative morbidity after lung resection even in patients with normal spirometry. Routine measurement of Dlco, regardless of spirometric findings, can help predict risk in candidates for major lung resection.

Sample Bronchoscopy Quiz QuestionThe attached pdf. shows a bronchoscopy photo question and answer similar to the those in the Bronchoscopy Quiz. Simply click on the Bronchoscopy Quiz button at the top of the home page to take the quiz. You will receive the number of answers you get correct after completing the 16 question Quiz. After you take the Bronchoscopy Quiz you have access to the bronchoscopy Simulator. We ask that you take the Bronchoscopy Quiz again after using the simulator and becoming familiar with fiberoptic tracheo-bronchial anatomy. After you take the quiz a second time you will receive the correct answers and you can compare anonymously the number you get correct with others who have taken the test. All results are confidential. Try it its fun and educational!